Sports Medicine Research: In the Lab & In the Field: Room for Improvement: Laws Regarding Traumatic Brain Injuries in Youth Sports (Sports Med Res)


Monday, June 10, 2013

Room for Improvement: Laws Regarding Traumatic Brain Injuries in Youth Sports

Reducing traumatic brain injuries in youth sports: Youth sports traumatic brain injury state laws, January 2009-December 2012

Hosea H., Harvey JD. American Journal of Public Health. 2013; ahead of print.

Take Home Message: In the United States, traumatic brain injury laws reflect a uniform, but not scientifically proven consensus about return to play time, who makes the return to play decisions, and the best delivery method to distribute educational information. None of the laws target injury prevention.

Forty-four states and Washington DC passed legislation to reduce the overall impact of traumatic brain injuries. However, there are no studies comparing the content of the laws with the current scientific literature regarding symptoms, treatment, and the effect the laws have on youth traumatic brain injuries. Therefore, the purpose of this study was to describe the current statewide youth sports traumatic brain injury laws and their relationship to established scientific literature of youth traumatic brain injuries. Westlaw and Lexis-Nexis databases were used to create a 50-state dataset of youth sports traumatic brain injury laws enacted between January 2009 and December 2012. The laws were coded to identify key variables, which included types of sports covered, age of target population, and reporting protocols. The laws primarily focus on secondary problems that arise following traumatic brain injuries and are modeled on the Lystedt framework (Washington; i.e., removal from play, evaluation by a health professional, and distribution of concussion information). None of the states enacted any primary prevention protocols. Forty-two laws include a mandatory removal from play when a concussion is suspected. Most laws require a minimum of 24 hours before return to play. Forty states and Washington DC require a young athlete to be cleared by third party before returning to play and almost all of these laws express that this third party must be a health professional. Only 26 states require that the health professional be trained in traumatic brain injury identification or management. Furthermore, 34 jurisdictions require traumatic brain injury information to be distributed to parents and/or guardians of student athletes. The content within the information packets are not specified in the laws, but the CDC’s material have been specifically mentioned in some of the laws. Out of the 45 jurisdictions that have traumatic brain injury laws only 25 explicitly require coach education in recognizing the symptoms of traumatic brain injuries in youth sports and the training requirements range from annually to every several years.

States across the U.S. are responding to the increased public awareness of traumatic brain injuries in youth sports by passing laws to improve identification and management. These laws vary little in their content across the states and none of the states focus on prevention. Many states implemented a minimum of a 24-hour removal period; however, 24 hours may not be enough time to safely monitor symptoms and conduct a graduated return-to-play protocol (McCrory et al., 2013). States seem to diverge the most regarding who is qualified to make the return to play decision. There are 19 jurisdictions that do not require traumatic brain injury specific training and there is no research whether or not this is appropriate and safe for youth athletes. The educational component is one of the most important aspects of the laws, but is lacking in its efficacy in helping parents prevent, identify, and respond to traumatic brain injuries because the content of the required educational information in most cases is not specified. Lastly, because youth sports typically do not have athletic training or medical personnel coverage during practice or games traumatic brain injury training for coaches is vital but the training standards are lacking in the laws. Furthermore, the laws do not try and regulate the content of sports activity like how many impacts is safe or banning specific maneuvers. This all suggests that we need to evaluate the existing laws to develop more comprehensive laws governing traumatic brain injuries in youth sports. It is important that we encourage not just evidence-based practice for traumatic brain injuries but also evidence-based legislation. As clinicians and researchers in sports medicine, we must work with the legislatures to improve the existing laws and when we believe the legislation is lacking we should help fill the gaps by raising the standards of education, awareness, and prevention in our communities.

Questions for Discussion: Do you think the current laws in place substantially improve the recognition and management of traumatic brain injuries in youth sports? Do you think changing the laws will help prevent concussions? What aspects of the laws do you think are the most or least beneficial?

Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffrey Driban

Related Posts:
Harvey HH (2013). Reducing traumatic brain injuries in youth sports: youth sports traumatic brain injury state laws, january 2009-december 2012. American Journal of Public Health, 103 (7), 1249-54 PMID: 23678903


Jennifer Sullivan said...

Ohh gosh...Brain injurt is a great threat to our country. It's a shame for our country and I really feels sad about it. The government should make some strict regulations on unauthorized fitness centers in the country. I think the authorized Sports specific training centers can help the country by making an effective awareness methods to the fitness aspirants

Catherine LeBlanc said...

Concussions and TBIs have received a significant amount of attention within the past decade and I believe that as compared to 15 or 20 years ago, these laws have improved the public's ability to recognize concussions and the importance of possible implications of concussions. However, the laws are not quite where they need to be to properly protect youth athletes. I agree that coaches should be properly trained to identify when a concussion is suspected, but that is not the main job of the coach. There needs to be more licensed medical professionals present at youth events for the best care possible; whether that is an athletic trainer, EMT or simply a first responder trained in recognition of concussions and TBIs.
Changing the laws to provide stricter standards for coaches and return to play progressions would be most beneficial in the management of concussions, however I do not believe that these laws could actually prevent concussions. Preventing concussions could be achieved through modification of the sports these youth athletes are playing to make activity safer, but I do not know if legislation would be able to play a part in changing rules.

Jane McDevitt said...

I agree with Catherine. There is a lot of pressure for coaches to take control of concussion injuries and it really isn't there job. The problem especially in youth sports is that there are not enough medical coverage at these games and practices. I am not sure if legislation can change the actual rules of the game, but I do believe they have the ability to mandate that there be medical personnel to cover at least the youth sport games. The problem we are going to face is money. Who is going to pay for the medical professionals to cover these games? It is a struggle to get athletic trainers into each high school and have enough for their own teams let alone the youth sports. Are there any committees or charities that organize volunteering medical professionals to coverage youth sports? If there is if one is developed do you think that could work?

Bethany Rohl said...

As Catie stated, concussions have gained a lot of attention in recent years. The laws are a step in the right direction, but do not go far enough. It seems that the laws are a few years behind the current research, which may be an issue with the legislation process itself. However, the laws that dictate who can determine return to play eligibility are on the right track. Simply having a child suspected of a concussion just sit out for 24 hours is not providing a due diligence. Making sure the athlete is symptom free and then progress them through a return to play criteria is necessary. Nevertheless, there is not an easily feasible way to improve concussion legislation in youth sports without increasing the health care providers on site during the practices and games.

Crystal Shirk said...

I feel like the education overload is actually making coaches send more concussion evaluations to the athletic trainer. Not necessarily putting the concussion in the coaches hands. They are now pulling kids and referring them. A lot of that depends on the relationships they have with their medical staff/ATCs

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